[Ovarian cysts and pregnancy]

Abstract

FREQUENCY AND HISTOLOGY: In the first trimester of pregnancy, ovarian cysts are often functional without complications. After 16 weeks of gestation, frequency of ovarian cyst is reported between 0.5 and 3.0%. Histological results are identical to those observed in non pregnant women between 15 and 44 years, essentially dermoid cysts and functional cysts. Frequency of ovarian cancer is reported between 1 out of 15,000 and 1 out of 32,000 pregnancies. A surgical intervention is necessary if suspect signs are observed at ultrasonographic examination.

Risk of complications: Almost all unilocular cyst with a diameter < 5 cm and persistent in second and third trimester are not associated with complications and are regressive during pregnancy; in this cases, abstention seems warranted. Conclusions are similar for dermoid cysts with diameter < 6 cm and without malignant criteria but there are a few studies on theses topics. No prospective studies are available to assess the risk of cancer or complications for cyst with diameter > 6 cm without malignant criteria.

Management: Evacuation by puncture is not well evaluated and is not recommended during pregnancy. If an intervention is decided, laparoscopy is warranted until 16-17 weeks. After 17 weeks, laparotomy is the most evaluated method.

Obstetrical consequences: They are uncommon and caesarean section is warranted only if a cyst in the pelvis will obstruct labour. During caesarean section, removal of a cyst should be performed.